Compelling commentary on children's health

Walt Disney it would seem is having a tough time of it when it comes to credibility with parents. Last year it was the Baby Einstein kerfuffle. This year they’re in hot water with the American Academy of Pediatrics. If you haven’t heard, their problems surround Eli Stone, a new legal drama making its debut on ABC January 31st. Apparently the attorney title character represents the family of an autistic child seeking vaccine related damages. As you can only imagine, the jury awards the plaintiff $5.2 million.

Just for grins, listen to the closing arguments Attorney Stone makes to the jury:

“Is there proof that mercuritol causes autism? Yes. Is that proof direct or incontrovertible proof? No. But ask yourself if you’ve ever believed in anything or anyone without absolute proof.”

(Perhaps he’s right. And one other thing: How do we know the refrigerator light goes off when we shut the door?)

One of the show’s creators who admits in the New York Times piece to not aggressively seeking to have his own children vaccinated suggests that viewers will draw their own conclusions regarding vaccine safety.

The American Academy of Pediatrics has appropriately protested over fear that the episode will fuel further vaccine skepticism. A vast body of evidence has grown to disprove the vaccine-autism connection. Thimerosal, the demonic element peddled by Big Pharma, has long since been removed from vaccines but the incidence of autism remains unchanged.

A class action lawsuit filed this week in California claims that Dannon has mislead all of us by claiming that its yogurt Acitiva helps regulate the digestive system. Perhaps I’ve missed something. Bifidobacterium regularis, the bug found in Activia, has been proven to exert a number of dramatic effects on the intestinal tract including improved transit time (makes things move better) as well as protection of the gut from colonization by harmful bacteria. For a great (but technical) review of what B. regularis can do, check out this recent review.

It’s important to understand that different yogurts contain different bugs that do different things. Each is unique in its effect on the body. While food manufacturers are prohibited from making specific health claims on their labeling (that would make them drugs), it would seem that from a pediatrician’s perspective, Dannon has been sufficiently neutral in their claims. Too bad it's come to this.

Lawyers aside, talk to your pediatrician and ask about the use of real yogurt in you child beginning late in her first year of life. Beyond Dannon's Activia, I like Stoneyfield Farms and their pet, Lactobacillus reuteri. If you recall, this is the same critter used in last year's screaming baby study. It's a small world.

As if The Great Wall of Bottles at Babies R Us wasn't long enough, late 2007 brought us yet another bottle system: The Adiri Natural Nurser. This beautifully bulbous, BPA-free back loading baby feeder resembles something from Woody Allen’s 1973 classic, Sleeper. Compelling really.

So is this medical innovation or marketing marvel? Is exquisite form met with exquisite function? It’s unclear.

Once beyond the wow factor, parents have to make the decision about whether this bottle will actually make a difference in what’s important: air swallowing. Remember that one of the most important factors in choosing a bottle is a baby’s capacity to sustain a comfortable, air-tight latch. In many cases this can only come through trial and error since an infant’s palate and latch will vary from child to child. What works for one baby won't work for the next.

While parents can feel empowered that they have yet one more option to consider when playing bottle roulette, only time, research and maternal testimony will tell us whether Adiri’s function exceeds what’s currently available on the market. For parents, change to meet what your baby needs and remember that in many cases, chaotic feeding is a consequence of acid reflux and other treatable conditions.

For Adiri, here’s what I would do:Get research. The bottle’s website has a conspicuous absence of any peer-reviewed literature suggesting that this bottle performs differently than other bottles. A new study from Boston Children’s Hospital published last year suggests that the liner systems such as that found in the Playtex Drop-in System beautifully replicate the swallowing and breathing pattern seen in breast-fed babies.Take a better position. It’s unclear how this bottle is different. Why as a pediatrician should I recommend this bottle to my patients? My grandmother used to tell me that looks are only skin deep. I need more.Dump colic. Finally, I might suggest avoiding the term ‘colic’ in marketing materials. Nothing is as unmistakably 20th century as indiscriminate use of the c-word. If you're confused, pick up a copy of Colic Solved.Give your publicist a raise. They’re doing a remarkable job. This thing’s had more press than Britney Spears and Barack Obama combined.

Hiding vegetables has become all the rage. The Sneaky Chef by Missy Chase Chapine and Deceptively Delicious by Jessica Seinfeld have hit the charts telling parents how to covertly deliver ‘healthy food’ to kids. Last week’s lawsuit involving the two sneaky chefs has me wondering if we should be fooling our kids at all when it comes to feeding.

Masquerading food is about us and our insecurities. It has little to do with what children actually need. Children have a remarkable capacity to take what they need when they need it. Our obsession with micromanaging vitamins, nutrients, colors and bites contributes to a stressful feeding encounter. I would go so far as to suggest that the food fight mindset supports an ideology of nutritionism which has been popularized by Michael Pollan in his fascinating new book, In Defense of Food. It’s worth a read if you’re concerned about the way we eat … or feed.

The interference that we create between a child and her food will do little to improve their long-term health or relationship with real food. Parents would do well to remember Ellyn Satter’s Division of Responsibility. And when we realize that parents make miserable dieticians, things can only improve.

Alert the media (and Jenny McCarthy), here’s another study showing that mercury-based preservatives in vaccines aren’t responsible for autism. The study published in this month’s Archives of General Psychiatry found that despite removal of thimerosal the prevalence of autism was unchanged between 1995 and 2007. Hopefully this will close the door on the Big Pharma witch hunt of the 20th century that undermined both the healthy and the afflicted.

And on the subject of autism, a study recently published in the journal Pediatrics found that children with autism spectrum disorder tend to be less irritable when febrile. Interesting stuff. The study is unable to answer why this is the case although in their discussion the authors offer a number of potential mechanisms for the observed behavior. Temperature related changes in nerve conduction and the neurological effects of fever associated compounds in the body topped the list.

While not a deal breaker, it’s studies such as these that offer small, incremental additions to the puzzle that’s autism.

The American Academy of Pediatrics today issued a clinical report to guide early feeding for children at risk for allergy. Breast-feeding again comes out on top but contrary to advice offered in 2000, food avoidance during pregnancy is no longer a concern. The clinical report if nothing else serves as an excellent review of what’s known about early feeding and the risk for allergy.

Here are the take home points:

1. The restriction of peanuts or other foods during pregnancy or breast-feeding doesn’t lower a child’s risk of allergies.
2. For infants with a family history of allergy, exclusive breast-feeding for at least 4 months can lessen the risk of cow milk allergy early in life.
3. Among formula fed infants at risk for developing allergies there is evidence that allergy be delayed or prevented by the use of partially hydrolysed formulas (Nutramigen, Alimentum, Good Start).
4. Soy-based infant formula has no role allergy prevention.
5. There is no convincing evidence that delaying the introduction of solids beyond 4-6 months has any effect on preventing allergy.

Beyond the part about giving mom free reign to enjoy a PayDay bar, the recommendation of hydrolysed formula for non breast-feeding babies at risk for allergy is interesting. As a man on the street (or clinic in my case) I would say that this isn’t anywhere near the standard of care and it’ll be interesting to see if the pediatricians pick up on it.